Provider Demographics
NPI:1649523556
Name:PRINCE OF PEACE HOME HEALTHCARE LLC.
Entity type:Organization
Organization Name:PRINCE OF PEACE HOME HEALTHCARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRAKELT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:520-868-0250
Mailing Address - Street 1:10640 N 28TH DR STE A101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2908
Mailing Address - Country:US
Mailing Address - Phone:602-441-3501
Mailing Address - Fax:602-865-1970
Practice Address - Street 1:10640 N 28TH DR STE A101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-2908
Practice Address - Country:US
Practice Address - Phone:602-441-3501
Practice Address - Fax:602-865-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34308251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health